Obsessive Compulsive Disorder (OCD) and Attention Deficit/Hyperactivity Disorder (ADHD) are very different conditions, according to the Diagnostic and Statistical Manual—the “bible” of psychiatric diagnoses published by the American Psychiatric Association. Yet, my clinical experience tells me they may be linked.

OCD is characterized by unwanted and intrusive thoughts and behaviors. A patient might complain that she “can’t stop thinking” about germs and, therefore, feels compelled to wash her hands dozens of times a day. It is as though the mind or brain is doing senseless laps around a track the person very much wants to stop running.

ADHD is characterized in part by distractibility, forgetfulness and trouble organizing. A patient might complain she “can’t focus” and never seems to finish a task. It is as if the mind cannot stay on course and complete even one lap around the track the person very much wants to run.

Different medicines (in addition to various forms of therapy) are used to treat OCD and ADHD. Obsessions and compulsions seem to yield to medications like Prozac or Effexor that boost serotonin and norepinephrine in the brain. ADHD seems to improve more with stimulants, like Ritalin or Adderall.

But for several of my patients, their obsessions and compulsions seem to have developed as a counterproductive way of “dealing with” preexisting and severe attention deficit problems. Since they couldn’t select what to pay attention to, and since that meant their focus shifted painfully from one thing to another to another, their brains seem to have dropped anchor into rigid, repetitive thought and behaviors (obsessions and compulsions)—so that they began to think or do the same thing again and again and again, in order to stop the very distressing sense of drifting aimlessly.

But it never occurred to me to scour the brain for times when I may have shown some ADHD tendencies.

Looking back, it’s still hard to know for sure.

I certainly had trouble focusing. I was one of the kids who went to a special class for kids who had trouble focusing. I was always daydreaming and staring out the window, but people with OCD do that, too. It’s just that we OCD types have brain-wrenching problems playing over and over in our minds. It’s not about dreams of flying pigs and fluffy clouds. Not that those things go through the mind of someone with ADHD.

I also used to imagine myself in certain scenes from movies and comic books, especially the Superman and Star Wars genres. I wrote about this in a previous post called “Hiding in Movies.” One time, in third grade, I got so carried away that I started to loudly hum the then-new theme to “Star Trek: The Motion Picture,” which had come out that year.

After that line of questioning, the doctor calmly told us Duncan fit all the textbook criteria of someone with ADHD. He also has some serious trouble with fine motor skills, which helps explain his penmanship.

We’ve long had our suspicions on both counts. But to hear it from a doctor’s mouth was something else.

We talked a lot about how family dynamics could really shape a kid’s struggles and how various mental disorders end up manifesting themselves. My family dynamic growing up took the mental ticks in my head and molded them into something very dark.

The doctor talked about medication. The good news: The stuff they prescribe for ADHD is extremely effective in correcting the brain’s wiring. For a few minutes, I thought that would be the road we were taking.

I wasn’t afraid.

I’ve been on Prozac for four years and know better than most that it works without wiping away my feelings and personality the way I once feared it would. One of our relatives recently worried aloud that medication would kill Duncan’s personality and turn him into something of a robot.

It’s a fair concern, but I know better. I’ve done my homework and used myself as a test case.

But what the doctor said next shattered any idea of medication — for now, at least.

He said that Duncan’s ADHD-like symptoms could also be the very beginnings of something much different — bipolar disorder, depression, maybe even OCD.

ADHD medicines can make those other things much, much worse further down the line.

At this point, we have Duncan seeing a therapist we’re very happy with. Spring is here, so some of his quirks are easing off a bit.

Dr. Ablow’s column doesn’t change the game for us. But it does give us something more to think about.

2 thoughts on “OCD and ADHD Linked? Maybe”

I didn’t suffer from OCD, but I could more likely fall into the ADHD camp. As a child, I suffered from concentration and attention problems in school, and as a result my grades reflected it. It was hard to know if it was related to boredom of the subject at hand, or just lack of interest; maybe a combination of both. I did suffer from what would today would be classified as depression or anxiety. I went through counseling at the time. I didn’t suffer from what would be extreme depression, but enough that I was just not a happy child. I had a lousy opinion of myself, low sense of self value, esteem and confidence. It lasted even into my college years, which made studying or wanting to succeed a challenge. Mediocrity was more comfortable to me; not standing out in a crowd. Being naturally shy probably didn’t help matters, nor being introverted as well. Unlike many other children, I didn’t object to being a loner. I could participate in a group O.K., but I preferred being on my own better.